In a ground-breaking study published in the Journal of Cardiovascular Magnetic Resonance, researchers have unveiled novel insights into ethnic differences in cardiac structure and function among healthy South Asian and White European populations in the United Kingdom. Conducted as part of the UK Biobank Imaging CMR sub-study, this research has brought to light the unique cardiac characteristics in these ethnic groups, employing state-of-the-art cardiac magnetic resonance imaging (CMR) to gather data. The research, taking the DOI 10.1016/j.jocmr.2023.100001, provides an unprecedented depth of understanding into how ethnicity impacts heart health in the absence of cardiovascular disease and associated risk factors.
Prior echocardiographic studies hinted at the existence of differential cardiac structures between South Asian and White European individuals, suggesting potentially lower ventricular volumes and more frequent concentric remodeling in South Asians. However, the use of cardiac MRI in this UK Biobank study has provided a clearer and more accurate picture of these disparities.
The study, led by Gaurav S. Gulsin from the Department of Cardiovascular Sciences at the University of Leicester, alongside a distinguished team of researchers, meticulously screened and matched 121 pairs of South Asian and White European participants. Healthy individuals without a history of cardiovascular issues, hypertension, obesity, or diabetes were selected, ensuring that the comparative results would reflect intrinsic ethnic variances rather than the consequences of the disease.
The findings revealed that, in comparison to White European counterparts, South Asian males and females presented with smaller absolute and indexed right ventricular volumes, smaller absolute left ventricular (LV) volumes, lower absolute and indexed LV mass, and reduced LV mass-to-volume ratio. These results imply that South Asian individuals have distinct cardiac dimensions which could be of clinical significance when diagnosing and managing heart health.
A striking aspect of the study was that despite differences in cardiac structure, there was no significant disparity in ventricular or atrial ejection fractions between the ethnic groups, indicating similar functionality in pumping blood. However, LV global longitudinal strain was heightened in South Asian females compared to White European females, and both South Asian males and females showed increased global circumferential strain.
Moreover, peak early diastolic strain rates – a measure of how quickly the heart relaxes and fills with blood after a contraction – were higher in South Asian males than in their White European counterparts. It’s noteworthy that this was not observed between females of the two ethnic groups. These differences, though subtle, provide an insight into the complex interplay of ethnicity, sex, and cardiac mechanics.
The study’s significance lies in its challenge to previous findings from echocardiographic studies which suggested more concentric remodeling within the South Asian cohort. Instead, CMR data points towards less concentric remodeling and heightened global circumferential strain in South Asians, offering a more nuanced understanding of ethnic variation in cardiac structure and function.
This UK Biobank study not only highlights the intricacies of cardiac physiology but also underscores the importance of considering sex- and ethnicity-specific criteria when establishing normal ranges for cardiac volumes and functionality. Tailoring clinical assessments to account for these differences is essential for precise diagnoses and personalized medical care.
Led by a highly skilled interdisciplinary research team including Parke Kelly S., Brady Emer M., Alfuhied Aseel, Motiwale Rishabh S., Razieh Cameron S., Singh Anvesha, Arnold Jayanth R., Graham-Brown Matthew Pm, Bilak Joanna M., Ayton Sarah L., Dattani Abhishek, and Yeo Jian L., the study exemplifies the importance of diversity in medical research. Such studies pave the way for more inclusive healthcare practices that can better serve the unique needs of varied populations.
The authors have conscientiously disclosed that they have no competing interests, emphasizing the integrity of the research and ensuring that its results stand solely to advance medical knowledge and practice.
With the growing appreciation for personalized medicine, this research is a step forward in developing ethnic-specific reference standards that could lead to better cardiovascular risk stratification and enhanced management of cardiac conditions in diverse populations.
This article serves as a critical reminder of the manifold factors that affect heart health outside of lifestyle and genetic predispositions, advocating for a more holistic approach to cardiovascular care that recognizes and accommodates for such differences.
Keywords
1. Ethnic Differences in Cardiac Structure
2. UK Biobank CMR Study
3. South Asian Heart Health
4. Cardiac MRI Assessment
5. Cardiac Function and Ethnicity
References
1. Gulsin, G. S. et al. Ethnic differences in cardiac structure and function assessed by MRI in healthy South Asian and White European people: a UK Biobank Study. J Cardiovasc Magn Reson (2024). doi:10.1016/j.jocmr.2023.100001
2. UK Biobank. UK Biobank: Imaging Study. Available at: https://www.ukbiobank.ac.uk/learn-more-about-uk-biobank/about-us/imaging-study
3. Gulati, M. et al. Understanding Ethnic Differences in Cardiac Structure and Function: The Contributions of MRI and Genetics. Heart (2022).
4. Petersen, S. E. et al. UK Biobank’s Cardiovascular Magnetic Resonance Protocol. J Cardiovasc Magn Reson (2016).
5. Ethnicity and Heart Disease. British Heart Foundation. Available at: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/ethnicity-and-heart-disease
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